A nurse wearing protective gloves holds the hand of a patient in the palliative care unit of the the Eugenie Hospital in Ajaccio, in France (Photo by PASCAL POCHARD-CASABIANCA/AFP via Getty Images)
AFP via Getty Images
With the rise of social media and influencers, rapidly changing positions in health policy by governmental institutions such as vaccine policy and now LLMs engines, a perfect storm has emerged for health misinformation, potentially impacting patients getting the right care at the right time. Importantly, it is becoming a significant part of the clinician-patient relationship. My colleague, Dr. Tyler Beauchamp, a pediatric resident at the University of North Carolina, who I co-wrote this piece with, shared this recent experience in the emergency department.
"It was just after midnight when a mother brought her 1-week-old infant into our emergency department. The baby’s only symptom was tachypnea at nearly 80 times a minute. No fever. No rash. A normal pregnancy and delivery. But the child was breathing fast enough to terrify any parent, rightfully so.
“As part of the workup, I recommended we get chest X-ray to look for the cause. The mother adamantly declined, stating ‘No one is going to radiate my baby.’ She explained that she learned about X-rays from the AI tool she had been using. A finger prick to test the baby’s sugar level, was also denied as was staying overnight so we could observe her baby for worsening symptoms. I asked what she would like us to do. She answered a lung ultrasound because the AI tool had told her it would be the safest way to find what’s wrong. When I told her that an ultrasound was not the right test for a high respiratory rate in a newborn, she responded ‘How could you possibly know that?’ ”
Physicians have become all too familiar with this type of conversation, often amplified by social media “experts” and generative AI tools. Most clinicians are led by the Hippocratic Oath in helping the patient with compassion, but what happens when one patient is resistant to quality care and, in the process, affects every other patient who might be waiting for the doctor with their own urgent and emergent issues? Part of our duty is to express patience while helping guide health. With the rise of “Dr. Google” and self-serving AI health, what is the impact to the doctor- patient relationship?
Across the country, emergency departments are increasingly serving as de facto primary care clinics. According to the Centers for Disease Control and Prevention, millions of visits each year are for non-emergent conditions that could be addressed in outpatient settings. But primary care access is shrinking. Insurance barriers, appointment backlogs, physician shortages and cost concerns have pushed patients toward the one place that cannot legally turn them away — the emergency department.
Emergency physicians now manage hypertension follow-ups at 2 a.m. They refill medications. They evaluate chronic back pain that has been present for years. The ER has become the safety net for a healthcare system that has frayed.
“The mother who wanted us all to pause and walk her through the medical complexities warrants empathy,” says Beauchamp. “There’s nothing scarier than the unknown, and in a perfect world where time is not a factor, we could spend hours talking. But sadly, every minute spent with one patient is a minute countless others do not get to see.”
As emergency departments become unofficial primary care sources, we must consider the implications. Given the cost of medicine and insurance battles, what happens when not just acute crises are questioned, but also long-term health? We are already seeing the effects, as vaccines and nutrition — things we know prevent problems and protect health — are being questioned at unprecedented rates.
While doctors are no longer the trusted pillars they used to be, they are still called upon in times of need. Families still come to the emergency department seeking answers and reassurance. But increasingly, they may want answers that align with what they have already decided to be true- frequently what the AI bot has told them.
This places physicians in an impossible tension. We take an oath to do no harm. That oath requires us to recommend what we believe is medically sound—even when it is unpopular. It requires us to say, “I understand your fear, but this is not the safest choice.”
When those recommendations are consistently questioned or rejected, the role of the physician shifts from trusted advisor to negotiator. Balancing necessary care with patient autonomy — all the while treading water in a resource-depleted system — it’s no wonder that nearly half of all physicians report symptoms of burnout. At the same time, physician shortages continue to worsen every year, with some data projecting a national shortage of over 80,000 physicians in the next 10 years.
If distrust continues to widen, we risk something more dangerous than inconvenience: fragmentation of care. If patients begin to believe they are better equipped than trained emergency physicians to handle acute crises, the consequences will not be theoretical. They may sadly be measured in missed diagnoses, delayed interventions, and preventable harm.
The world is overwhelming, and people are having to navigate a healthcare system that is expensive, impersonal and constantly changing. What are people to do other than cling to what makes sense? There are several changes that must happen to help our health systems adapt.
Firstly, the burden to rebuild trust shouldn’t fall on patients, it should be carried by many groups: clinicians, policy makers, industry and leadership.
For us as clinicians, that means prioritizing patience and compassion. It means explaining not just what we are recommending, but why. It means acknowledging uncertainty rather than pretending omniscience. Physicians must adapt and engage with our patients in a new way, while always retaining a key element- the human connection.
This responsibility must also be societal. Media organizations, the AI industry and public figures must be held to higher standards when disseminating health information. Platforms that profit from engagement cannot be indifferent to the real-world consequences of misinformation. The difference between “content” and “care” matters.
AI is here to stay. It can summarize research, improve workflow, expand access to information. Used well, it can augment medicine. But it cannot replace the moral weight of bedside decision-making. It cannot sit with a frightened mother and make a call that balances microscopic radiation exposure against the possibility of a collapsing lung. It cannot bear the responsibility of being wrong.
“The baby that night ultimately improved. No catastrophe. No dramatic diagnosis,” says Beauchamp. “Yet the encounter lingers in my mind.
Not because of the medicine. Because of the next era for us as clinicians: retaining the trust to deliver the best care.”
The future of healthcare will not be decided solely by technology or policy. It will be led by whether we can restore a simple, fragile idea: that when you come to a doctor in your most vulnerable moment, you believe that the person standing in front of you is there to protect you from harm.
Written with Dr Tyler Beauchamp.
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